The Handbook of Discourse Analysis

456 Nancy Ainsworth-Vaughn
the sequential organization of encounters. Physicians in Shuy’s data apparently were
filling out a written questionnaire during the encounter. Shuy expected that the
topics of the encounters’ discourse would be clearly related to the questionnaire.
He reports:
One startling conclusion faced me at the end of my examination of some 100 interviews:
It would be very difficult to reconstruct the written questionnaire on the
basis of the tape-recorded interviews. . . . not all interviews cover the same topics
and by no means are all questions covered consistently across all interviews. The
range of variability was, in fact, gross. (1983: 22).
In other words, in Shuy’s data, patients’ and doctors’ local negotiation changed the
encounter away from the doctors’ previously established design for the discourse.
Shuy’s subsequent discussion casts his results in terms of the possibility that
medical encounters can be conversational to a degree. Shuy suggests that patients
are more comfortable with encounters that are more conversational. This raises
the issue of genre: are encounters fundamentally interviews which can be modified
toward conversation, or fundamentally conversations that have been modified to
create interviews?
2 Genre
The question whether medical encounters are fundamentally conversational or interview-like
appears in several major analyses. Frankel points to early studies in which
researchers suggested that the encounter “is essentially conversational in nature”
(1979: 232). Frankel remarks that the “case [has not] been made convincingly”
(1979: 233). 1 Instead, he suggests, the restricted turn-taking system of the medical
encounter is in contrast with that of conversational discourse, especially in regard to
questions.
Ten Have’s (1989) discussion of genre in medical encounters suggests that there is
“simultaneous relevance of several different interactional formats” (1989: 115). Ten
Have examines one such format, troubles-telling, a conversational activity. Confusions
occur when patients think they are being invited to do troubles-telling. So ten
Have sees that conversation can be one of the interactional formats that participants
in encounters orient themselves toward, but that this can be “problematic,” as physicians
resist the format.
Heritage appears to agree with Frankel that institutional discourse is defined by
restrictions on speech activities: “Institutional interaction seems to involve specific
and significant narrowing and respecifications of the range of options that are operative
in conversational interaction” (1989: 34). But, in contrast to Frankel, Heritage’s
formulation might suggest that he sees medical discourse as essentially conversational
in nature.
Both Maynard (1991) and Ainsworth-Vaughn (1998b) identify speech activities which
are found in conversation and in the medical encounters the researchers studied.
Maynard shows that “doctor–patient interaction involves sequences of talk that have